238 - Orogastric Tube Prolonged Use and Palatal Anatomy in NonKetotic/Hyperglycemia Infant

Introduction: Nonketotic hyperglycinemia is an inborn error of metabolism of autosomal recessive genetic origin. This condition causes early neurological manifestations and damages the central nervous system.
The most common features are hypotonia, lethargy, inability to suck and difficulty feeding. Due to severe hypotonia, difficulty in sucking and prolonged use of oro/nasogastric tubes, these patients present changes in the anatomy of the arches and maxillary atresia.

Case Report: The patient was diagnosed at birth with nonketotic hyperglycemia and at the age of one year started treatment with severe maxillary atresia.
The proposed treatment consisted of digital compression with the index fingers positioned bilaterally at the level of the transpalatine cleft with light transverse pressure (until small local ischemia) sliding anteroposteriorly. Maxillary expansion therapy was performed for 6 months up the occlusion and harmony between the arches were established. The digital compression exercises were performed by the patient's parents, who are also physical therapists, after receiving appropriate professional guidance. The parents repeated the procedures in the presence of the researcher 3 times to ensure correct performance. The patient is currently undergoing motor and sensitization work and has been progressing to oral meals for approximately 1 year, with chewing guidance for liquid or pasty textures, with progression of dysphagia, oral mobility, and the entire oropharyngeal complex. Despite the severity of the case, digital compression therapy provided symmetrical and satisfactory maxillary expansion to establish occlusion for the deciduous dentition as shown in the clinical pictures before and after treatment.